In This Bulletin:
- Important Tailored Plan Announcement
- Updated: Partners Offers NC Medicaid Managed Care Virtual Education Series
- NC-TOPPS Initial Interview, 3-Month Update Compliance
- IRIS Report Expectations
- Claims Information
- State News and Updates
- Training Resource and Collaborative (TRAC)
- Community Training
- Additional Events and Training
Important Tailored Plan Announcement
The N.C. Department of Health and Human Services (NCDHHS) announced on Feb. 27, 2023, that the launch of the NC Medicaid Managed Care Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans (Tailored Plans) will be delayed until Oct. 1, 2023.
Tailored Plans, originally scheduled to launch April 1, 2023, will provide specialized services for individuals with significant behavioral health conditions, intellectual/developmental disabilities (I/DDs), and traumatic brain injuries (TBI) as well as physical health and pharmacy services.
Until Oct. 1, Partners members will continue to receive their behavioral health services and I/DD and TBI supports through Partners and their physical health and pharmacy services through NC Medicaid Direct. The delayed start of Tailored Plans allows Local Management Entity/Managed Care Organizations (LME/MCOs), which will operate the Tailored Plans, more time to contract with North Carolina’s hospital systems and other providers to support member choice and continuity of care.
While the operation of Tailored Plans will begin Oct. 1, 2023, Tailored Care Management will continue through the delay. Through Tailored Care Management, members will have a single designated care manager supported by a multidisciplinary team to provide integrated care management that addresses the member’s whole-person health needs.
Click here to read more.
Update: NC Medicaid Managed Care Virtual Education Series
Virtual Education Events for Partners’ Tailored Plan Members and Recipients
NC Medicaid Direct is expected to go live as planned on April 1, 2023. Partners will have a virtual informational session on March 28 to welcome new members and provide an overview of the Medicaid Direct Health Plan.
The remainder of the NC Medicaid Managed Care Virtual Education Series will be postponed due to the N.C. Department of Health and Human Services decision to delay the launch of the Tailored Plans until Oct. 1, 2023.
Watch for future dates and how to register in late summer. Click here for details.
NC-TOPPS Initial Interviews, 3-Month Update Compliance
Effective April 1, 2023, Partners will recommend that all agencies not in NC-TOPPS compliance with their Initial Interviews and Three-Month Updates complete a Plan of Action.
The Three-Month Update for NC-TOPPS compliance was recently generated for Fiscal Year 2023 First Quarter and Fiscal Year 2023 Second Quarter. Initial Interview Timely Submission for NC-TOPPS compliance was also generated for Fiscal Year 2022 Fourth Quarter and Fiscal Year 2023 First Quarter.
If your agency was out of compliance for either of the two consecutive quarters, please use the Plan of Action template found here.
The Three-Month Update and Initial Interview scores can be found on the NC-TOPPS Quarterly Key Performance Indicator Scorecard for your agency. The scorecard indicates which locations failed to meet guideline standards of 90% for Three Month Update Timely Submission; as well as the months that failed to meet the guideline standards of 80% for Initial Interview Timely Submission.
The Plan of Action is a systematic method of eliminating or minimizing the reoccurrence of out of compliant findings. The Plan of Action should be used as a tool and submitted to NCTOPPSQUESTIONS@partnersbhm.org.
This is to prevent future Plans of Correction based on low compliance scores. It is recommended that you use the template to aid in improving your agency’s NC-TOPPS performance before a Plan of Correction is required. A Plan of Correction is required once performance continues to be below the standard for two consecutive quarters. If your agency continues to fail to meet the compliance standard, a Plan of Correction will be implemented.
If you have questions or concerns, email NCTOPPSQUESTIONS@partnersbhm.org.
IRIS Report Expectations
The Incident Response Improvement System (IRIS) is in place to ensure that serious adverse events involving persons receiving publicly funded mental health, developmental disabilities, and/or substance abuse services (MH/IDD/SAS) are addressed quickly. It is used in analysis and trending to prevent future occurrences and improve the service system. It is imperative that Providers follow the state guidelines to report incidents for a proper follow-up to occur. It is essential that providers complete the IRIS report as fully and thoroughly as possible. As guidance and reminders of the timelines, please see the below table taken from the Incident Response and Improvement Reporting Manual:
Providers’ expectations specific to Level III Incidents/Deaths:
- Response Expectations
- Provide Partners with internal investigation results within 72 hoursfrom the creation of the IRIS report.
- Respond to any follow-up questions within 48 hours from when they were posted in IRIS.
- Upload any additional documents to IRIS and/or reports requested coming external from the provider (ex. Medical Examiners Report, Death Certificate, DSS, DHSR, Law enforcement) as soon as possible upon receipt.
- Failure to respond may result in
- Follow-up by provider specialists.
- 1:1 meeting with the provider.
- Attendance of Provider in Partners Quality of Care Committee to discuss.
- Potential Plan of Action (POA).
General IRIS reminders:
- IRIS reports are not to be submitted via email unless the IRIS system is down. In the event, the IRIS system is down and an IRIS report is submitted via email that the provider is still expected to submit the report into the IRIS system, once the system is back up.
- Please do not send IRIS report numbers to the LME/ MCO or anyone outside of their provider agency.
- For IRIS-related questions please reach out to:
- For Partners IRIS Training:
- IRIS Reporting and Technical manual Link:
Providers are reminded to contact the Claims Department at firstname.lastname@example.org for all claims-related questions. To avoid delays in receiving a response, please do not contact individual Claims’ staff directly.
Explanation of Benefits Requests for Coordination of Benefits Claims
As a reminder, Partners requests copies of the Explanation of Benefits (EOB) for members’ claims submitted indicating Coordination of Benefits. The request will originate via email from Partners’ Claims staff. Please submit the information, via secured email, prior to the date indicated in the emailed request. If a response is not received, the original claim payment will be recouped.
Reminder: Taxonomy Code 193200000X and 193400000X
Taxonomy Code 193200000X and 193400000X should not be submitted on claims as the rendering taxonomy code. All claims submitted with this taxonomy code as the rendering code will be reverted.
Partners is committed to paying claims in a timely manner and adheres to Prompt Pay Guideline Compliance as set forth by the state of North Carolina. In order to ensure that all providers receive EFT payments as outlined in signed contracts, providers are required to submit the proper financial documentation, which includes banking information. If you need to add new banking information or are requesting a change to current banking information, you may email email@example.com or call 704-884-2523.
|February 2023: Medicaid—Number of Days to Process and Pay All Claims|
|Received Date to Paid Date:||9.3|
|Top Five Medicaid Claim Denials for February 2023|
|Claim Denial||Provider Recommended Action Steps|
|Service is not authorized.||Verify Service Authorization for member. Contact Utilization Management.|
|Claim received after billing period.||Write off charges as non-billable. Do not rebill.|
|Duplicate claim.||The claim has previously been submitted and adjudicated. Do not refile.|
|No coverage available for Patient/Service/Provider combo.||Go to Patient -> Patient Search and search for the patient in question. Check the insurance to ensure the patient has effective insurance covering to the date of service submitted on the claim. If this appears to be correct, contact the Managed Care Organization (MCO) for further assistance.|
|Client has other insurance (COB).||Ensure the primary insurance for the member has been billed and is indicated on the submitted claim.|
State News and Updates
- Joint Communication Bulletins, which are issued by the N.C. Department of Health and Human Services, can be found here.
- Medicaid Bulletins: All bulletin articles are available here. Providers are encouraged to frequently review this information.
- Medicaid Pharmacy Newsletters are available here.
- NCTracks: Providers are encouraged to review NCTracks communications. To subscribe to NCTracks communications, click here.
Training Resource and Collaborative (TRAC)
The TRAC offers a centralized cross-functional selection of required trainings, collaboratives and events. Click here to view what is coming up in the next few months.
Tailored Plan On-Demand Provider Trainings
The N.C. Department of Health and Human Services (NCDHHS) requires the listed trainings be available for providers. This applies to Tailored Plan, Medicaid Direct and State-funded providers. Registering is easy. You will be prompted to enter simple registration information. The on-demand training will then be available immediately or when your schedule allows. Note: Training Reciprocity Among Tailored Plans. NCDHHS is allowing the six LME/MCOs reciprocity for some Tailored Plan-required trainings.
The Office of Minority Health has established culturally and linguistically appropriate services (CLAS) Standards to address health equity, promote cultural competence, and to improve health outcomes. This training will review the fifteen CLAS standards and identify resources and training materials available to providers at no cost on the website, thinkculturalhealth.hhs.gov.
This on-demand webinar covers the following (but not limited to) four dispute types: Medicaid appeals, non-Medicaid appeals, Provider disputes, and Grievances.
In the EPSDT training, you will learn: What is EPSDT; Partners EPSDT requirements; Periodicity Schedule; Diagnostic and Treatment Components; Medical Necessity Review; Service Coordination (Vaccines for Children, Into the Mouths of Babes, and Developmental Delay and Referral to NC Infant-Toddler Program); and EPSDT components, diagnosis codes, modifiers, referrals, tracking, follow-up and outreach.
Fraud, Waste and Abuse
This webinar covers (but is not limited to) the following: Regulatory Compliance Program, Types of Health Care Industry Oversight, Partners Program Integrity Department, Program Integrity Department Function Highlights, What are Fraud, Waste and Abuse (FWA), Potential Areas or examples of FWA and the Impact of FWA on health care.
Into the Mouths of Babes (IMB)
The IMB program trains medical providers on how to provide preventative oral health services to Medicaid-insured children from tooth eruption to age 3 ½ (42 months). Goals of the program include preventing and reducing early childhood tooth decay and increasing referral of high-risk children to a dental home. This training is required before being permitted to receive reimbursement for IMB services.
Partners Hand Washing and Personal Protective Equipment (PPE)
This new provider required training is now available on-demand. Participants will gain an understanding of infection control using PPE and frequent handwashing.
Partners Infection Control: Home Care Settings
This new provider required training is now available on-demand. Participants will gain an understanding of infection control in the home care setting, which includes learning ways infections are transmitted, standard precautions and how to teach members about infection control procedures.
Partners Infection Control: Community Care Settings
This new provider required training is now available on-demand. Participants will gain an understanding of infection control in the community care setting, which includes learning ways infections are transmitted, standard precautions and how to teach members about infection control procedures.
Prevention and Population Health Management
Partners takes a population-based approach to improve the overall health of Medicaid members and State-funded recipients and collaborates with community partners on targeted initiatives. In this training, you will learn about: Partners Prevention and Population Health Core Philosophies, Program Goals, Partners Prevention and Population Health Approach, Provider Level Interventions and Partners Prevention and Population Health Programs Overview of Provider Expectations.
Provider Training-Live Virtual and/or Prerecorded
Person Centered Thinking (PCT)
March 20 and 21, 2023, 9 a.m.-4:00 p.m. (Register)
Person Centered Thinking (PCT) is a foundational and philosophical framework for those involved in supporting people with disabilities. This activity-filled, two-day training consists of applied stories, guided exercises, group work and discussion. This approved National Learning Community Curriculum meets the requirements of NC service definitions.
Partners Provider Council
March 24, 2023, 9:30 a.m. (Register)
The Partners’ Provider Council is a professional representative of and advocate for all service providers in the Partners’ service area. The Council facilitates an open exchange of ideas and brings forward concerns and solutions while promoting collaboration and mutual accountability among providers. Meetings are held on the fourth Friday of the month. An intellectual and developmental disabilities (I/DD)/Innovations Provider Breakout Session will immediately follow this meeting.
NC-TOPPS Monthly Webinar
April 5, 2023, 2 p.m.-2:30 p.m. (Register)
Please join us the first Wednesday of every month for new NC-TOPPS updates. This is also an opportunity for everyone to share new ideas, provide mini trainings as well as ask questions. Please let us know if you have any specific topics you would like us to discuss during the monthly meetings. For questions or comments for NC-TOPPS, email us at NCTOPPSQUESTIONS@partnersbhm.org.
Target Audience: Existing and new providers in the Partners Health Management network.
Provider Open House
April 6, 2023, 9 a.m.-10 a.m. (Register)
The Provider Open House is a virtual event that occurs the first Thursday of each month from 9 a.m. to 10 a.m. and is open to new and existing providers in the Partners Health Management network. You can enter questions in the question/comment box during registration.
The Provider Open House begins promptly at 9 a.m. and is staffed by all the usual department representatives ready to respond to your questions. We ask that you use our Zoom Registration process in advance of the open house and add your question(s) directly into the Zoom Questions and Comments box. This effort on your part, will help us better help you. Of course, your questions are welcome during the open house as well. You may place them in the chat box upon entering the Zoom meeting. Our intention is to address your questions or concerns in a private one-on-one breakout room, and we understand that your question may require further follow-up. We look forward to your participation.
If you need accommodations to participate in the Provider Open House, please email firstname.lastname@example.org.
Partners Diversity and Inclusion Collaborative – Quarterly
April 13, 2023, 2 p.m.-3 p.m.
This is a closed work group designed to bring awareness and increase conversations about diversity, equity and inclusion within the LME/MCO and provider agencies. It reviews and develops policies and procedures that promote best practices and works to remove systemic barriers to minority providers. To request more information about this work group or to learn how to become involved, please contact Vickie Smith, email@example.com.
All Trainings are virtual via Zoom and last two hours unless otherwise specified. For more information contact Jeanne Patterson, firstname.lastname@example.org or Amber Matthews, email@example.com.
Trauma Informed Care
March 17, 2023, 2 p.m.-4 p.m. (Register)
Let’s look at how our behavior affects others with trauma history. What are some simple changes we can make using what we know about trauma?
Why Faith in Harm Reduction
March 20, 2023, 9 a.m. – 11 a.m. (Register)
The Gaston Controlled Substances Coalition invites you to attend Why Faith in Harm Reduction, a free two-hour program for people and communities of faith looking to initiate and expand their ministries to persons impacted by opioid use disorder.
Partners Community Café
Fourth Wednesday of each month, (March 22, 2023), 10 a.m.-11 a.m. (Register)
Join Partners for our monthly Community Café, where we focus on relevant issues, concerns and ideas to improve the lives of those we serve. Community Café is held on the fourth Wednesday of each month. This month’s Community Café will provide information on how to support individuals with intellectual/developmental disabilities.
Darkness to Light
March 23, 2023, 10 a.m.-noon (Register)
This training provides education about child sexual abuse and the steps you can take to prevent and report child sexual abuse. Seats are limited. Please register early.
QPR (Question, Persuade, Refer)
March 27, 2023, 2 p.m.-4 p.m. (Register)
Many have experienced recent losses. The risk of suicide is still high. This evidence-based training teaches the skills to intervene in a suicide crisis. **The maximum number of people allowed to participate in a virtual QPR training at one time is 30; registration is on a first come first serve basis.
Risk & Resilience Buffering Toxic Stress Modules 1-3
March 28, 2023, 10 a.m.-noon (Register)
This training provides information about how early childhood stress and trauma can result in negative outcomes in areas of learning, behavior and health throughout the lifespan. The definition of early childhood mental health as promoting healthy social emotional development through nurturing young minds from birth throughout early childhood is the core principle of this training.
Risk & Resilience Buffering Toxic Stress Module 4 Limbic Calming and Module 5 Cortical Coping
March 29, 2023, 10 a.m.-noon. (Register)
This is a follow-up to Modules 1-3. Module 4 teaches how to help very children calm their limbic systems. In Module 5, we will learn about healing the cortical brain to develop active coping skills such as impulse control and problem solving.
Risk & Resilience Buffering Toxic Stress Module 6: Building Adult Resilience
March 30, 2023, 10 a.m.-4 p.m. (Register)
We have focused on young children and how we can support their development. This final one-hour module shifts to the importance of well-being in adults and how we can continue to build our resilience. Modules stand alone and there are no prerequisites to attend any of the modules.
Jeff Gordon’s Child Advocacy Center Celebrates Child Abuse Prevention with Actress Jan Broberg
April 4, 2023, 3 p.m. (Register)
Actress Jan Broberg, who is a survivor of child sexual abuse and appears in the Netflix documentary series “Abducted in Plain Sight,” shares her story of resilience. “I’m here to inspire people to heal and move forward from sexual abuse,” she said. “I believe everyone should have a happy childhood…at any age.”
*An Introduction to Child and Family Teams: A Cross System Training from the Family’s Perspective (CFT Part 1) – This is System of Care Training*
April 25-26, 2023, 9 a.m.-4 p.m. (Register)
CFT 1 is a two-day experiential training (when you register, you agree to attend both days) with a goal of providing an overview of Child and Family Team (CFT) meetings from the family’s perspective. The training seeks to reinforce the idea of “one family, one plan” by addressing Child and Family Teams through the lens of multiple systems as they affect families in their everyday lives. Agency representatives and parents/family members over 18 years of age are encouraged to attend this training. Sessions must have a minimum of 10 participants. Please do not schedule other appointments during this training. Register soon. This class will fill quickly.
Partners System of Care/Community Training Coordinators
Jeanne Patterson 980-989-0345 firstname.lastname@example.org
Amber Matthews 828-433-6693 Amatthews@partnersbhm.org
Starla Jordan 704-813-3402 email@example.com
Stefanie Robbins 704-918-3094 firstname.lastname@example.org
Stephanie Funderburk 980-363-5952 email@example.com
Meghann Lail 704-616-3159 firstname.lastname@example.org
Additional Events and Training
Forsyth County Mental Health Town Hall
March 16, 2023, 6 p.m. – 7:30 p.m. (Register)
Join the Forsyth County Mental Health Town Hall for a community discussion on improving behavioral health and resilience in children and youth across North Carolina. N.C. Department of Health and Human Services Secretary Kody Kinsley, Senator Jim Burgin and other local leaders will join the conversation after introductions. The event will be held at the Forsyth County Commissioner Chambers, 201 N. Chestnut St., 5th floor, Winston-Salem, NC 27101.
Hickory Brain Injury Support Group
March 28, 2023, 6 p.m.-7:15 p.m.
Connect with survivors, families, and professionals. Meetings offer help, hope, and education, so you can live a happy and successful life after brain injury. This group meets on the fourth Tuesday of most months from 6 to 7:15 p.m. in the Community Room at First United Methodist Church, 311 3rd Ave NE, Hickory NC 28601. Times and locations sometimes vary. Meetings may occur online if there is a COVID-19 surge.
For more information, contact Travis Glass at 828-781-0778 or email@example.com. Also check facebook.com/HickoryBISG. Each meeting will be followed by 15 to 30 minutes of mindfulness awareness education and practice.
Disability Support Professional Training
Mount Eagle College and University is now offering Disability Support Professionals (DSPs) the opportunity to earn national certification in their field through an accredited curriculum instructed by individuals with lived experience. To learn more about the program, please email firstname.lastname@example.org or visit https://mounteag.com/contact/ to submit a contact form.
Partners Community Collaboratives
Partners sponsors a monthly community collaborative in each of the counties in the service region. Community Collaborative groups consist of representatives from local government agencies, community organizations, and service providers, as well as individuals, families and advocates who work together in a specific community to identify and solve problems for children, adolescents, adults and families struggling with mental health and substance use.
Together, group members:
- Identify gaps in services.
- Partner with agencies and families.
- Develop helpful resources.
- Assist providers and families with issues related to services.
- Ensure access to quality services.
Currently, all collaboratives are meeting virtually. If you are interested in learning more about a group or attending, please email Partners Community Engagement.
Select a county below to go to the associated collaborative information: